Participants

The Royal College of Speech and Language Therapists (RCSLT) lists 25 accredited Higher Education Institutes (HEIs) approved by the Health and Care Professions Council to train SLTs in the UK. These HEIs offer a range of programmes at pre-registration level including undergraduate, masters level and apprenticeship courses. This list was used to tabulate the current HEIs and courses in the UK. The Committee of Representatives of Education in Speech and Language Therapy, which has representation from all HEI SLT program directors, was contacted on 23^rd April 2024 via the RCSLT and asked to circulate an email to committee members, with a request for information about the study to be forwarded to staff teaching dementia content. Following this several staff contacted the researchers. Over the second week of June 2024 further information was sent directly to HEIs via the generic university email addresses, located from university websites, that had not yet been in contact. Six representatives from HEIs responded explaining that participation was not possible due to current time constraints, or content was taught by outside clinical staff who were not able to attend. By the end of June 2024 twenty-four representatives across 19 HEIs had expressed an interest in participating in the study.

Prior to attending a focus group meeting participants were asked to completed a brief survey collating demographic data about their courses and indicating their availability for a focus group meeting. The survey remained open from 5^th August 2024–3^rd September 2024. All participants were offered the opportunity to participate in the preparation of the manuscript as co-authors in a future publication of the study results, with the proviso they contribute to interpretation of the data, reviewing the manuscript, providing final approval of the manuscript and agree to be accountable for the work, in line with journal criteria.

Procedures

An online survey was developed jointly by the lead and final author, AV and JK, to address research question 1; What support and training are currently being provided for pre-registration student SLTs on the topic of dementia? Participants were asked to complete the online survey hosted on the UCL approved online platform Qualtrics [39] answering 16 questions providing demographic information about their courses and the dementia teaching they provide (level of course- BSc, MSc, apprenticeship, how many hours of dementia teaching, who does the teaching, what is included in the teaching and placement opportunities. They were also asked to provide a brief comment on the local challenges around dementia teaching and whether they had any relevant resources they felt were unique and useful to share (see supplementary S2 File for the full list of survey questions).

Survey participants who expressed an interest in attending a focus group by sharing their email address received email-invitations to one of two 90-minute focus meetings, held on the online videoconferencing platform Zoom. The email provided information on all organisational issues (i.e., time and date, calendar entry, videoconference link, anticipated duration, privacy and request for response). Researchers met prior to the meeting to test out technology on the day, introductions allowed for testing of microphones and for participants to settle into the meeting. Participants were able to see and talk to each other and the facilitator, who was one of the researchers, during the meeting. All participants reported they were familiar with zoom. The chat was also and was used to share the focus group questions in written form as well as verbally. At the end of the first focus group a debrief was held between AV, JK and RT to identify any issues with moderation.

Participant demographic data about individual focus group participants were not collected, and it was agreed that all quotes would be carefully anonymised to reduce the risk of identifying the views of individuals or institutions and to allow for open and honest conversations. Focus group meetings were facilitated by a speech and language therapy researcher (co-author RT) not currently involved in dementia education, but familiar with the clinical area. Researchers AV and JK met to discuss the results from the initial survey questions and develop the focus group topic guide. Survey respondents noted that dementia was a difficult subject for some students and not all universities reported teaching the same dementia related topics. Some universities reported that student SLTs were able to access clinical placements within the field of dementia, but others were not. While the survey addressed the first research question; summarising the support and training currently being provided for pre-registration student SLTs on the topic of dementia, it did not provide details of the experiences or opinions of those lecturers in delivering this training, and exploring what should be taught to improve confidence and competence in student SLTs to enable them to work with people with dementia. For example, the survey data did not explain the variation in placement experiences and whilst topics within the teaching were listed there was no depth in terms of the rationale for these choices, and why this was relevant in terms of improving the competence in student SLTs to enable them to work effectively with people with dementia. To provide in-depth, narrative-based explanations for the initial findings AV and JK drafted topic guide question to consider these areas, thereby addressing research questions 2 and 3. Questions probed reasons for the variation in placement opportunities, rationale around priorities for current teaching and what lecturers thought should be taught to improve confidence and competence with context and reasons (see supplementary file 3 and 4 in the supplementary materials for the topic guide and full breakdown of survey data). Notably answers to the final two questions from the survey (barriers and resources for sharing) were felt to be too brief to allow for interpretation. The focus group topic guide therefore aimed to invite participants to provide deeper, richer responses to enable fuller interpretation. The topic guide draft was shared with co-researcher RT, an experienced speech and language therapist for feedback and revised with his feedback re clarity and use of prompts. The final topic guide (see supplementary S3 File) comprised seven open questions, with several accompanying probes, and contributors were encouraged to expand or clarify responses where required by the facilitator, RT. Consequently, the first focus group was attended by six participants, the second by 12 participants. AV and JK attended both meetings to provide technical support. AV and JK were also participants in the first focus group. Whilst this is a power dynamics risk, this was managed by setting a clear ground rule with the moderator RT that after the initial introduction AV and JK only contributed once other group members had spoken in the first meeting, thereby ensuring everyone had a voice. In the second meeting it was made clear to participants that AV and JK would not speak during the interview component. In total the focus groups included 18 participants. Importantly, in terms of reflexivity, AV, JK and RT explicitly discussed and reflected on their biases as colleagues during the development of the topic guide, acknowledging that in their roles as both facilitators and researchers they might influence the interactions. Both focus group meetings (totaling approximately 183 minutes) were video recorded and automatically transcribed using Zoom software. Co-author MG watched the video and manually edited the transcription to ensure accuracy, and to check that all names, places and any other identifying information was anonymized.

Analysis

Closed responses to survey questions were analysed using descriptive statistics including means and range. Open responses were explored to inform the focus groups as described.

The research team, AV, RT, MG and JK analysed the transcribed focus group data using reflexive thematic analysis [40,41]. MG, a speech and language therapy researcher specialising in dementia from Germany, was invited to participate in the analysis process to deepen the interpretation. Being mindful of AV and JK’s relationship with the participants (as colleagues and peers), it was felt that MG could provide an alternative view. In line with guidance from Braun and Clarke [42] the researchers were striving to ensure their reflexivity and maximise their subjectivity through thoughtful analysis, and the addition of MG was felt to support a more inductive data driven approach through unmotivated looking and analysis. Authors AV and JK also produced a video recording of initial themes and shared this with all 16 remaining participants (excluding themselves), nine of whom responded. This enabled the further interrogation and refinement of identified themes. Fig 1 provides a detailed account of the analysis process.

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Fig 1. Detailed account of the reflexive analysis process.

https://doi.org/10.1371/journal.pone.0327090.g001

Survey responses

18 respondents from 16 universities across the UK completed the survey, (this represented two universities where two participants submitted identical responses under different participant names). Data represented universities delivering BSc courses only (6), MSc only (2) both BSc and MSc (5) and all three (BSc, MSc and Apprenticeship courses (3). Teaching on dementia within each course ranged from 4.5–20 hours, with a mean average of nine hours. Further details are captured in Table 1.

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Table 1. Survey responses describing dementia teaching on speech and language therapy courses at 16 Universities across the UK.

https://doi.org/10.1371/journal.pone.0327090.t001

1. What are the experiences of the lecturers in delivering this training?
2. What do lecturers think should be taught to improve confidence and competence in student SLTs to enable them to work with people with dementia?

Thematic analysis of focus groups

Eighteen participants from the same 16 universities represented in the survey participated in the focus group meetings. Six main themes were identified in the qualitative focus group data that described the experiences and opinions of lecturers involved in teaching student SLTs about dementia; 1. Dementia is a vast and therefore complex topic, 2. There are biases about dementia within and outside the profession, 3. Students bias towards dementia can be shifted through exposure, 4. Teaching could be enhanced by threading dementia through the curriculum, 5. There are several tensions in teaching on dementia: Possibilities versus clinical realities now and in the future, and 6. Dementia teaching must focus on person centeredness.

The following provides a detailed description of each theme, accompanied by relevant quotations from participants (using the letters A-S as identifiers) across the two focus groups:

1. 1. Dementia is a vast and therefore complex topic

Participants described that just like many other communication difficulties, dementia can be complex, making it difficult to teach. The breadth and heterogeneity of dementia were important component of this, meaning that participants felt dementia was a vast and expansive field, encompassing many different and often nebulous diseases that take time to explain to student SLTs:

We have to help students to understand just how many symptoms can present and how different it is between individuals. And I think many students’ minds are blown. [It] really requires a good meaty chunk out of teaching time to explain that complexity. (participant O)

Students were felt to benefit from frameworks to explain new concepts, yet dementia is not easily explained in this way. Participants described that in order to provide comprehensive information, dementia teaching needs to cover a range of speech, language, communication, cognitive and swallowing abilities and difficulties. The range of presentations, at different stages of the dementia, caused by a variety of underlying diseases or aetiologies that changed over time, could mean that information was potentially complicated and confusing for students, e.g., I think it gets a little bit muddied in this sort of general umbrella term. (participant A)

Albeit somewhat overwhelming, foundational knowledge can be delivered through university teaching of SLT students. However, participants advocated that further development of knowledge is required beyond what it is possible to provide in the brief hours that are available in the training. Experience in the workplace was also felt to be vital to achieving this post-registration skill development. Historically teaching was felt to be inadequate to prepare people for clinical practice:

When I did my training, we literally had. I’m not joking. We had 10 minutes at the end of the aphasia course on head injury and dementia, or 15 maybe. (participant E)

Developing skills in working with people with dementia who have communication needs was felt to be a new area within the profession, making it vulnerable to reductionist attitudes or being overlooked in preference for swallowing:

It’s still a relatively new area within our profession. There’s a lack of tradition in our profession compared to say stroke and aphasia and the danger for the future is that... EDS [eating, drinking and swallowing] within dementia overshadows communication within our whole profession. (participant R)

The newness of working on communication with people with dementia was considered to add to the complexity, resulting in it being a less comfortable and more challenging field of work:

Maybe for some of us we feel a bit more reticent, because it’s outside of our comfort zone, whereas the sort of traditional aphasia and stroke tends to be much more something that we’re – we’re confident with. (participant A)

Participants attributed the feelings of discomfort to the historical nihilistic views that there is nothing that can be done for people with dementia. Whilst this view has changed, as research has demonstrated the positive impact of speech and language interventions, this previous view was felt to be pervasive, with a continued impact on both the profession and the literature in this field:

I think it’s historically been quite underrepresented within the profession. So, I think you know, for me when I first started teaching, we didn’t have very much on dementia, and I think you know we’ve had to kind of try and change perceptions around dementia. And obviously that’s helped with it being quite high on the kind of political agenda as well..... I think there’s a lot of fear of you know. What do we do with people who have these progressive conditions. (participant J)

Participants conveyed a sense that the complexity in teaching communication in dementia did not only rest with the condition itself, the diagnostic and prognostic difficulties and the combination of language and cognitive communication difficulties, but with the historical attitudes and lack of research evidence about the role of speech and language therapy in dementia:

People are not giving [it] attention. They’re not calling it aphasia. It’s much more new into the field, right? The post-stroke aphasia has been around from Second World War very well entrenched, but dementia [and] PPA is like 1990s, and in the last 20 years it has picked up so it will take time to for, you know, clinician academics to catch up. (participant C)

1. 2. There are biases about dementia within and outside the profession

Biased views about the role of speech and language therapy in dementia were felt to be genuine barriers to teaching students. Importantly, the historical attitudes towards dementia within the profession were only felt to be one element of this. This bias was greatly exacerbated by broader biases in society about dementia that presented negative representations of people with dementia in the media:

The societal stigma around dementia as being a living death, and you know all of those terrible….I won’t go into [charity] marketing campaign around dementia but I think there’s a lot of stigma that that dementia is this really distressing? I say [to the students], living death is often how it’s described in the media, and I think that’s unhelpful and inaccurate. They should also say that people can have really positive lives with dementia, but I think that probably adds to the fear and upset that people have when they think about dementia. (participant N)

The stigma of dementia was highlighted as a problem impacting attendance at lectures. Participants reported students frequently approached them prior to and during lectures to share concerns, anxiety and fears:

I’ve had experience of many years of teaching speech and language therapists at all stages of their career about dementia, and there’s always been tears. Before I’d ever heard the term trigger warning I started to introduce that because I found that it was grandparents. It was parents. It was people’s own worry about their own memory problems. (participant R)

Participants reported spending significant amounts of time trying to unpack these pre-existing biases in lectures. A participant from one university had consulted with people with lived experience of dementia who had emphasised working through these biases as a priority for teaching. Several participants described innovative ways of encouraging students to do this in lectures, using reflective tasks and comparing these to photos and AI representations to challenge students’ assumptions:

I wonder if now, with the use of AI, we can be utilizing that more effectively within our teaching as well people with dementia. So, for example, I, when we were doing the challenging kind of stereotypes of older people. I got AI to generate a whole bunch of images of people with dementia, and we talked about how they were all wrinkly old people. (participant D)

The concept of having to unteach biases included a feeling that most other teaching related to children and adult communication needs focused on restitution and rehabilitation in terms of the SLT role. This meant that when teaching dementia (as with other progressive conditions) there had to be work done to re-calibrate students’ knowledge and expectations around intervention goals and therapy approaches:

Looking at your outcome measures and what you’re trying to achieve out of any therapy that you’re providing, because with stroke, you are looking for some sort of restorative in some form or some resolution or improvement, whereas with dementia (…) you may be able to resolve some issues in the very short term but actually, you’re looking at that longer term picture where the chances are you are going to have continued difficulties and increased difficulties throughout that time. (…). It’s planning for that as well as kind of working on the here and now. (participant E)

Some participant lecturers reported that it was challenging to make dementia an exciting subject area to teach because of the progressive trajectory of the disease. One participant explained that dementia could potentially be viewed as less exciting and held negative connotations for students:

When we’re teaching about stroke and aphasia, and we’re talking about rehabilitation, and the students get quite excited about the potential for rehabilitation, and then we move on to dementia. I think that generally the understanding in dementia is that the picture is quite grim, and that people are progressing, and it doesn’t seem as exciting, perhaps, to the - to the students as the potential for Rehab. (participant A)

1. Students bias towards dementia can be shifted through exposure

Participants described a need to shift student’s perspectives by providing them with exposure to dementia, thus creating new experiences and changing biases. Experiencing dementia through the media or news was not felt to provide any help nor equip the students to meet a person with dementia:

I think it can address the fear dementia sounds really scary, and people, if you’ve only ever read a book about dementia, you could feel very ill equipped to handle an interaction with someone with dementia. (participant R)

Unfortunately, exposure to dementia prior to the course in some instances reinforced stigma and distress. It was not uncommon for students to bring personal experiences related to dementia to teaching staff, such as upsetting family experiences. Whilst students were found to have personal experiences in relation to several communication disorders that are taught on speech and language therapy courses, personal experiences of dementia were particularly variable, at times distressing and often instilled inaccurate representations of the condition or the role of the SLT:

A lot of students seem to have accurate or inaccurate fairly strong ideas about what dementia is, or strong personal stories or links...or a strong sense of what the SLT role might be in dementia. (participant R)

Despite the general opinion that more experience would improve understanding of dementia, students reported inconsistent experiences of dementia on placements. These could be polarising and serve to either enhance the students’ positive opinions of the role of the SLT in dementia or provide pessimistic and traumatising experiences as these contrasting statements illustrate:

Exactly like you’re saying they they’d say the most things like we didn’t expect them to have a sense of humour. You know, some people with dementia are actually really fun. And they say that they’re really fun to work with. (participant F)

I’ve seen in the acute setting with taking students round, and there was a lady who was accusing the student as soon as she walked in about stealing her fruit, you know so, and just being able to handle that and not sometimes [feel] that, that’s a bit scary for them. You know. How do I feed into this reality. How do I behave? (participant G)

I think the first time I ever went into a care home was [as] a speech and language therapist, you know (…) I still remember it now of being, you know, quite an intense experience really and unfamiliar. And so, for a lot of students that might, that might be the first time they’ve been into a care home and potentially so that that could, that could be a challenging experience. (participant S)

Some placement experiences can trigger memories of personal experiences and become interwoven with personal experiences:

The emotional impact that some of our students have fed back to us. I think some students have fed back when they’ve had a relative who has had dementia and has perhaps passed away, and that experience of going and visiting them in the care home and things, and then having a similar experience on placement that has brought up, you know, certain feelings for them that they found quite upsetting, and that we’ve kind of had to support them through. (participant Q)

The reality of some clinical services was felt to exacerbate stigma and fear amongst student SLTs, or even spread false beliefs about speech and language therapy not being at all effective:

I’ve had some of the attitudes of the other speech language therapists quite problematic in terms of you know, like the kind of what’s the point of it. Kind of oh, you know what is this? It’s not proper work. (participant F)

Even when they’d had positive experiences, some students perpetuated negative views of placements focusing on communication therapies as somehow inadequate because it is not ‘direct’ therapy with the person to improve their communication abilities. This was felt to be associated with stereotyped views of the SLTs role or prior training in impairment or restitutive interventions skewing students to describe approaches such as life-story work or communication partner training as ‘indirect’ work and by implication therefore not ‘real’ speech and language therapy:

The proper work is [perceived as] direct work with the patient where people improve and then this other stuff (...) Even the term indirect boils my blood, because it’s still direct with somebody, isn’t it? (…) And there’s this kind of you know, ‘we couldn’t do that. So we did this’. So it’s already sort of prefacing it as something that’s of a lower standard. (participant C)

Students had reported to participants that placement supervisors would occasionally not allow them to see people with dementia as they were ‘too complex’. Or placement supervisors themselves felt less confident in working with people with dementia on communication:

They’re de-skilled a bit with doing so much dysphagia now and such little communication, that actually, that that can be a bit scary, can’t it? (participant F)

However, with expanding cohorts of students, there were not enough placements available for all students to meet people with dementia. This was often attributed to misconceptions about placement purposes among SLTs in clinical practice and participants felt responsibility for forging improved relationships with placement providers to assure them that these were valued learning opportunities for students:

Not all mental health services are taking student placements. And I think that is a big problem for the profession. And I think that is something that we kind of need to think about, and that seems to be a pattern across the country. Some places will take students very regularly, other places won’t, and this. I’m never quite sure whether it’s the therapist, or whether they’ve got some misconceptions about what they think the universities expect of them, and our places do quite a lot of work. We’ve tried to support those discussions, and you know, so it. And then that therapist changes. (participant F)

Given some students did not see anyone with dementia on clinical placement, alternative means of providing a range of experiences of dementia was felt to be necessary. Purpose-built opportunities for all students to meet people had been introduced at some universities with widespread positive effect, for example running groups on campus.

Other participants had explored opportunities through non-NHS providers, and non-SLT providers:

We are actually trying to find other solutions. For example, working with charities, you know, placement with charity sectors as one option [such as] carer groups. So, it’s not directly with the patient themselves, but actually with the carer and other support groups which supports dementia. (participant C)

Simulation experiences and video recorded patient experiences were considered possible alternatives:

So, a lot of the students will come to the end of their last placement close to graduations, that they might have not had the opportunity to see any cases with dementia. So, as part of the teaching, it’s important to take this into consideration. Present some videos, some cases, just to make sure that they get that exposure. (participant K)

Some participants also emphasised the importance of trying to inspire students, and enthuse them during their teaching, to dispel myths and emphasise the vast range of opportunities to develop the profession in a positive way:

I’m often saying things like: Oh, you know, this is the biggest expanding caseload for speech and language therapists, because more and more people are getting dementia. We’re going to see them all on our caseload. And you know, the research field is expanding as we speak. So, I try, and I talk about it that way, and there’s so much opportunity. (participant E)

1. Teaching could be enhanced by threading dementia through the curriculum.

Participants felt there was an opportunity to increase teaching on dementia by threading dementia teaching through the curriculum in a practical way to teach several important topics. In fact, dementia was seen as a useful vehicle to teach on topics such as neuroanatomy, dysphagia, decision-making and mental capacity, ethics, family support, cognitive communication disorders, and multidisciplinary working:

I’ve been trying to influence some of my peers on other modules. So, for example, the stats teaching when the stats module coordinator asked for examples of different research methods. I found a paper on dementia, and I was like: Use this! Use this! And, for example, we’re doing some more qualitative [teaching] again I found some qualitative research methods. For the mental capacity teaching I’ve tried, which I do part of I’m always trying to get examples of dementia clients into that. (…) I coordinate the research module in our course. So, I’m just. I often try and use dementia as an example across in terms of showcasing the research (…) It’s about threading, isn’t it? Potentially, and influence across. (participant E)

Dementia was considered a useful clinical example to support development of complex clinical skills as well as building resilience. By including dementia in several if not all areas of the curriculum some universities already reported successes in foregrounding dementia as a key clinical area for the profession:

So the dementia theme kind of runs through the curriculum...It doesn’t have its own module... we sort of drip feed a little bit more dementia in there as well, so that it’s not seen as a separate thing to everything else. And it’s a key clinical topic. (participant B)

Threading dementia through the curriculum was felt to be a natural progression within the teaching curriculum. It was felt to benefit several other areas including dysphagia, Parkinson’s disease, Motor Neurone Disease and other progressive disease groups:

I touch on it in loads of other spaces as well. (…) the growing kind of eating, drinking, swallowing components that we’re teaching on. Dementia comes up all the time. And yeah, you just find that you are talking about it in lots of different spaces. (participant M)

From a practical perspective this was often achieved through case examples:

We use examples of dementia cases, right? So that’s other place where I felt we could embed the idea of dementia across the curriculum. (participant C)

Given the rising number of people with dementia participants proposed the need for a radical change within the curriculum to ensure representation of a condition of growing importance to the profession:

1. There are several tensions in teaching on dementia: Possibilities versus clinical realities now and in the future

Throughout both focus groups participants expressed a tension in teaching dementia. Some of the concerns were about the lecturers’ own confidence and skill set in teaching this topic:

Some of us we feel a bit more reticent, because it’s outside of our comfort zone, whereas the sort of traditional aphasia and stroke tends to be much more, something that we’re – we’re confident with. (participant A)

Other participants highlighted tensions in where the teaching was placed within the curriculum, for example across and within progressive and non-progressive acquired conditions, emphasising that whilst there are commonalities across communication disorders, there are also significant differences, as expressed in this example where dementia teaching was grouped alongside the teaching of head injury:

It got shared between myself and head injury and we found that when we were trying to collaborate to write this session together, we really couldn’t, although we agreed on what is cognitive communication. How does cognition impact actually the kind of assessment was very, very different, and the purpose was very different. (participant D)

There was felt to be a significant tension between the current clinical reality, where people with dementia are often deprioritised on clinical caseloads, compared to the future aforementioned “paradigm shift” (participant A), where people with dementia could access speech and language therapy for communication needs. This shift was felt to be both inevitable as our population ages yet remained currently aspirational. Despite this, participants felt strongly that there needed to be some change:

I just wanted to highlight that with the increasing numbers of people living- living to an older age, there’s quite a – there should be quite a paradigm shift in our education, because we are going to be seeing more of the people living with dementia, whether it’s in community settings or the hospital. And I think there’s quite a lot of work to be done with changing perceptions and altering perceptions and assumptions on people with dementia and their ability to express themselves and understand. (participant G)

It was acknowledged that SLT provision for people with dementia in the UK was underfunded, particularly for communication services and so participant lecturers were faced with the dilemma of whether to teach the current clinical reality or what the evidence base indicated was possible given adequate resources. Awareness and teaching of both was acknowledged as important:

What I teach in my sessions versus what is the reality for services that are very stretched and have students out on placement. Sometimes it’s getting that balance right between what I’m saying can be done and what we can do as speech therapists and what we can achieve versus what is funded, commissioned. You know what we actually have time for, and that little bit of mismatch.

Gold standard versus sometimes the more realistic sort of situation. (participant M)

It was acknowledged that communication was often deprioritised in the current reality, due to the overwhelming numbers of clients with difficulties with eating, drinking and swallowing difficulties. This was often reflected in the profession and the placements, where dementia placements focused on dysphagia, with no communication experiences:

EDS [eating, drinking and swallowing] within dementia overshadows communication within our whole profession. (participant R)

A lack of awareness of the role of the SLT within the care pathway was also an issue:

I went to a care home to see a client with dementia and said I was there for

communication, and the staff at the home said, I didn’t know you did that [they] thought, speech and language therapy was swallowing. (participant B)

People don’t have awareness [of SLT] only in PPA or memory clinic they are, you know, they see the value. (participant C)

Understanding the ‘gold standard’ for SLT practice was considered a method for empowering future generations of SLTs to advocate for, and plan for the right kind of services:

I make a real point of saying; this is the ideal. This is what we want you to aspire to and actually want you to advocate for and you’ll be in a position once you’re in clinical practice to start trying to do that and putting in business cases. (participant D)

1. Dementia teaching must focus on person centeredness

At the center of the discussion on quality of life was person centered care. This was an inarguable key component of all teaching on all communication difficulties, but felt to be exemplified within the field of dementia care:

We’re teaching person centered care and kind of holistic care in all different etiologies. But I think particularly in dementia. It’s so important to think about person centeredness and talk to our students about person centeredness, and also, including the people around the person, with dementia as well. In our interventions. (participant H)

Person centered care was described as an aim of all teaching and care for people with dementia and therefore was considered a foundational approach within teaching. Exposure to dementia was identified as essential in developing the skills of empathy that are at the heart of this approach.

Those sorts of experiences really resonate with them, and then their management and their assessment, and all of that is, is more likely to be influenced. I think, developing empathy rather than an academic understanding or pity from being able to relate to a person we can teach person centredness. (participant R)

As such person centered care required staff to teach students both how to understand the theory and then apply it in their practice. This was considered the lynchpin and brought together teaching with placement experiences and exposure to dementia:

We asked some of our experts by experience what we should cover in teaching. And so, their feedback was (...) about acknowledging stigma and challenging those stereotypes that people might have around dementia. The other thing that they highlight as well was how to how to talk to us with a capital “us”, and rather than talking to family carers. (...) And then the other thing that they highlighted was about valuing them as individuals, and how it’s important to see the value that people living with dementia can contribute. So, it’s not just about focusing on disability but focusing on ability. (participant N)

Despite this overwhelming agreement amongst participants that person centred care was a central component for teaching, one participant flagged that there is not a lot of literature that explains how this is operationalised in terms of delivery of clinical speech and language therapy. Participants acknowledged that it takes time and practice to develop person centred skills:

It’s a very practiced clinician that feels comfortable going into a setting and not having to whip out a form to fill in to guide them. (participant B)

The concern being that SLTs often continue to assess, or take detailed case histories instead of spending time with families and getting to know the person deeply:

Person centred care and how you know some of them get. And then some of them don’t. And it’s like, you know that kind of move away from the test battery, you know, and it and it’s at what? At what point I mean it. And it’s that underpinning stuff. (participant F)

It’s not a case history taking. You’re building a relationship with them. And you’re seeing what their issues are from their perspective. But if I’m honest, (…) I don’t know where to find the literature to help me with that. (participant F)

However, in this discussion participants started to describe the clinical practice of being a person centered speech and language therapist as “building a relationship” (participant F) with the person and their family and getting to know people’s individual communication difficulties, as expressed succinctly here:

Drilling down into what are the unique communication needs or difficulties of someone with one of the dementias. (participant A)

Strengths and limitations

Work undertaken in the research study has brought together speech and language therapy lecturers from across the UK to explore teaching to ensure students develop competencies that meet the needs of people with dementia and their families. Two focus groups were held, with a much larger group of participants attending the second meeting, meaning it is possible that not all participants were given equal opportunities to respond. Whilst 18 representatives from 16 universities were involved, it was not possible to engage all 25 higher education institutions in the UK and therefore this may be a limitation of this study. To protect anonymity, demographic data collected about focus group participants was presented in a way that prevented cross referencing. This may have reduced the possibility of developing more in-depth insights to participants individualized opinions and linguistic, cultural or ethnic biases. Despite the action taken to address the power dynamic, the presence of the first and last author at the focus group discussions may have influenced what participants did or didn’t share. Importantly, however, almost all focus group participants were able to contribute the time and work to be co-authors on the paper, demonstrating their commitment to better address the needs of people affected by dementia in student speech and language therapy training. Whilst it was not probed or raised during the focus groups, future research on teaching student SLTs must explore linguistic, cultural and ethnicity needs of people affected by dementia. No people affected by dementia themselves were involved in this study, so it is difficult to know if the themes and components identified will really meet the needs of people with dementia. Future research should explore this more fully.